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| Texas HMO comparison reveals doctor and patient complaints |
| By Insure.com |
|
An updated guide to Texas HMOs shows that while consumers are more satisfied with their HMOs than last year, the number of complaints continues to increase. Since the last report card, the annual complaints per HMO member increased nearly 14 percent, according to the Office of Public Insurance Counsel (OPIC).
| While consumers are more satisfied with their HMOs than last year, the number of complaints continues to increase. |
OPIC has published its third annual consumer guide to Texas health insurers that allows consumers to compare the performance of their HMOs on quality measures, including the number of complaints lodged against an HMO by both doctors and patients. (Read the complete guide at OPIC's Web site. You'll need Adobe Acrobat Reader to view the document.)
The guide is based on information collected from July 1, 1999, to June 30, 1999, and submitted by Texas health insurers to OPIC, the Texas Department of Insurance, the Texas Health Care Information Council, and the Texas Department of Health. It includes information on how consumers rated their plans' customer service, the overall quality of their health care, and how well the plans' doctors communicated with them.
"These reports provide insight into how well HMOs are responding to the health care needs of their members," says Rod Bordelon, OPIC's executive director.
"Texas has increased consumer protections and awareness and consumers are using these opportunities in greater numbers," Bordelon says. "These reports hold HMOs accountable and force greater attention to the service provided to consumers."
The report is available as booklets corresponding to the state's seven regions — central, east, north, south, and west Texas, the Panhandle, and the Gulf coast. These booklets provide consumers with data specific to each of the above listed regions. More than 3 million consumers are enrolled in Texas HMOs at a cost of over $4.7 billion in annual premiums, according to OPIC. |
Texas HMO complaints: July 1, 1999, to June 30, 2000
Source: The Texas Department of Insurance |
HMO |
Enrollment as of Dec. 31, 1999 |
Health care provider compaints per 10,000 enrolled |
Patient complaints per 10,000 enrolled |
Combined patient/provider complaints per 10,000 enrolled |
| Aetna U.S. Healthcare of North Texas |
137,761 |
29.33 |
25.91 |
55.24 |
| Aetna U.S. Healthcare |
181,765 |
7.70 |
12.65 |
20.36 |
| Americaid |
106,693 |
-- |
-- |
-- |
| AmeriHealth |
51,301 |
12.67 |
10.53 |
23.20 |
| CIGNA HealthCare |
92,182 |
20.94 |
36.99 |
57.93 |
| Family Health Centers |
54,552 |
0.55 |
-- |
0.55 |
| Harris Methodist Texas Health Plan |
294,171 |
12.07 |
11.08 |
23.15 |
| Humana |
275,290 |
13.40 |
20.16 |
33.56 |
| Kaiser Foundation |
112,024 |
-- |
0.98 |
0.98 |
| Memorial Sisters of Charity |
96,843 |
382 |
9.29 |
13.11 |
| Methodist Care |
60,314 |
4.48 |
11.60 |
18.07 |
| PacifiCare |
176,741 |
10.52 |
23.71 |
34.23 |
| PCA Health Plans of Texas
(has been acquired by Humana) |
79,741 |
12.16 |
21.19 |
33.36 |
Prudential HealthCare |
529,234 |
9.60 |
12.40 |
21.99 |
| Rio Grande HMO |
173,775 |
17.72 |
14.73 |
32.46 |
| Scott and White Health
Plan
|
153,367 |
0.13 |
2.35 |
2.48 |
| SHA
(FIRSTCARE) |
97,764 |
4.19 |
10.23 |
14.42 |
| Southwest Texas HMO
(formerly NYLCare Southwest) |
205,204 |
26.17 |
14.67 |
40.8 |
| Texas Gulf Coast HMO
(formerly NYLCare Gulf Coast) |
402,977 |
11.86 |
23.92 |
35.78 |
| Texas Health Choice
|
125,455 |
42.72 |
60.82 |
103.54 |
| United
Healthcare
|
299,816 |
19.41 |
15.28 |
34.69 |
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Last Updated Dec. 11, 2000
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